OBJECTIVES: The aim of the current study was to investigate the inter-tester reliability of the MSI classification test items in patients with neck pain. METHODS: sixty subjects with neck pain (18-65 years) participated in this cross-sectional study. The examination of each patient, included the evaluation of signs and symptoms during posture and movement tests and the MSI diagnosis of subjects with cervical pain, was performed simultaneously by three testers in one session. Kappa and gamma values were used to determine the measure of agreement between testers for each of the test items and classification judgment. RESULTS: The kappa values for inter-tester reliability of the sign items ranged from 0.36 to 1. For the symptom items kappa values ranged from 0.36 to 1. The kappa values of inter-tester reliability for patients' classification judgments ranged from 0.71 to 0.73. CONCLUSION: The inter-tester reliability between three testers according to the MSI approach for neck pain classification, sign and symptom was generally acceptable.